Removing that Which is in the Way
When you are crashing through deadlines, cramming the research for six live interviews per day into your brain, and Victoria Sweet's new book flutters into your lap, it feels like a healing opportunity indeed.
You are forced to slow down. You are encouraged to rethink what you call "healthcare" and the essence of the men and women you call "healthcare providers."
You are encouraged to rethink a lot of things.
"Slow Medicine: The Way to Healing" is a contemplative book and, quite possibly, a revolutionary one. When broadcast time approached, Dr. Sweet was wise and present and generous with her time as well.
The trasncirpt of our conversation is below. But first ...
I encourage you to pause. Consider what it truly means to consider your body more akin to a plant than to a machine. Now consider the call to remove what is "in the way" of your own healing.
Is it a medication? Is it a toxic relationship? Perhaps, as Dr. Sweet suggests, it might be a personal/cultural anxiety, or the frantic flurry of daily living that stands in your way.
You cannot bust through these barriers with a sledge hammer, Dear Listener. You cannot unravel the knot all at once.
But you can slow down (if only for a short while) for deep conversation, for noticing, for reading. You might even seek respite within the pages of Victoria Sweet's latest book.
Relax and alllow yourself to rethink everything you thought you knew about the intersection between modern and ancient medicine, between your own healing and what stands in its way.
A healing balm indeed.
The following is an edited version of this conversation. To listen to it in its entirety, click here.
Welcome to In the Moment, I'm Lori Walsh. Protocols ignore patients, doctors provide healthcare rather than practice medicine, and humanity slips away in favor of the commodity that healthcare has become. Dr. Victoria Sweet is the award-winning author of God's Hotel. Her new book is called Slow Medicine: The Way to Healing. She joins us now from Silicon Valley in California.
I would be remiss if I didn't talk first about how beautifully written this book is, and how it takes its place immediately in this canon of literature that's written by physicians. So much of this is about your personal journey. What solidified for you, in the writing of this book, compared to the writing of God's Hotel?
So, after God's Hotel, I had sort of felt like I had done my bit, you know. And I wasn't planning on writing a second book. But I began, because I did a lot of speaking, I began hearing the same thing from people in every audience I spoke at, which was, first, "My doctor doesn't look at me anymore." And at the same time, in the last five years, I started seeing how much the direction that we were headed was not the direction I thought we should go, and felt we were losing the soul of medicine, actually. As healthcare began to really take hold as a principle.
But it wasn't really until my own dad was admitted to the hospital with the wrong diagnosis, he had a seizure, and they decided he had a stroke. And that even I, as a physician, who knows my way around hospitals, could not get anybody to look at him, to realize he had the wrong diagnosis, to get them to change this path they were on, which was treating him as if he were a stroke victim.
And the fact that I could not get that to happen, even though they were reading God's Hotel, the doctors and nurses happened that month to be reading God's Hotel in their book club. They wanted me to sign their books, so they were clearly the kind of people who wanted to practice the kind of medicine I'm talking about, and yet they weren't, and they couldn't.
We finally got my dad out by declaring him to be a hospice-level care-so then they were like, "Okay, he can go home." They took out all the IVs, he went home. And then he did recover. But he would have died if I, we hadn't done that.
This is a remarkable story, because I've talked to hospice people before, and they'll say, "Well, not everybody comes to hospice, you know, some people graduate from hospice." And I was a little skeptical about that as a concept, when they tell me that. But this is a perfect example, you take him home and feed him a steak, and he starts his road to recovery, boom.
Yeah, that's right. And for me, that actually wasn't surprising, 'cause I had seen that a lot. We can get back, but the most egregious example was when I was at Laguna Honda, this old-fashioned hospital, and I got a patient who had been admitted, who was 36 years old. And she was admitted with a broken leg, to recover. But I realized that she'd been there before, so I called up her old chart, and she'd been admitted to hospice six years before, with end-stage cirrhosis, and had gotten better once they took her off all her meds. Gone out, gotten married, gotten pregnant, and lived long enough to break her leg and come back.
So, yes, hospice is amazing, once you take people off all the meds that they've collected.
But yes, that was the story that really ... I was really shocked, I really was shocked, I'm like, "Oh my god, if I can't do it, nobody can." And we seem to be losing even this sense of what medicine, doctoring, being a patient, what it's really about. And that's what impelled me to, as you say, solidified, my, the way I wrote this book and what I wrote about, and how personal it is.
Yeah. What are some of the key things that are really broken? What's in the way? As you say, these doctors are reading the book in their book group, they want you to sign it, they get it. In some ways, they want to be practicing medicine.
So what's in the way, simply, is that they are no longer able to spend their time with the patient. They have to, they have to spend all of their time, and more of all of their time, in front of a computer. And just again, to just stretch this out one second, is that, after he got home and got better, and I spent a couple of months before I decided I was going to write about it, because it's pretty personal and pretty intense. And I also wanted to make sure I hadn't been missing something. You know, maybe he did have a stroke. Like, didn't ... I had examined him, but maybe he did.
So I got his electronic health records, so I got his medical records, after a couple of months, and I looked at them. And so, of course, they came in a little CD, and I put them into my computer, and I realized in the 10 days he was there, there were 812 pages of records.
So first thing, I was like, "Wow, no wonder all these doctors and nurses weren't doing anything else, they were generating 810 pages of records." That was the first thing. And the second thing, was that all those, the records, were useless. They were worse than useless, I couldn't ... I spent four hours with them, and I couldn't, when I finished, tell you what medications for sure he was on, or how he got the diagnosis of stroke.
They began in a way that wasn't the whole story. What's the significance of that?
They were, yeah, it was all just pieces. They were all just little pieces of the story, but you couldn't even put it together, because they were all scattered. It was clearly made for a computer, the program, so the docs ...
So what's in the way is that, in the last 10 years, we've basically taken our doctor time and nurse time, and we stuck them in front of a computer, and told them -- and there's no way for them to do their job, except sitting in front of that computer. They literally ... So, until we get our time back, that's where we're at.
Okay, so what are they missing, in just a regular, you know, a checkup, or a conversation, a consult with your doctor? They come in, that laptop is up, they're not looking at you, for starters, they're looking at the screen.
How important -- I guess, what I'm really asking is -- how important is the exam? How important is the story?
So, for me, the exam is crucial. And I had the good fortune to work at this old-fashioned hospital for many years, where we were kind of undiscovered. God's Hotel is sort of -- it wasn't really undiscovered, I'm exaggerating a bit -- but it was not ... We really had enough time to do a good job. Very interesting patients, and I had a chance to really hone my physical exam skills, 'cause it was hard for us to get a CT scan or an MRI. We had to get an ambulance, and send the patient to a different hospital.
But I had the time, right, so I got quite good at a physical exam. And I think a physical exam is probably the most important thing, even more important than listening to the patient. I mean, towards the end of my years there, I talked with the patient afterwards, but I mostly wanted to see them, and smell them, and touch them, and take my own blood pressure, get my own pulse, and do the whole extensive physical exam I had learned as a medical student.
Because the body is where the diagnoses are. Exactly in the patient's body, you know. It's not in the computer, the patient's not a computer. The answer's not in the computer, it's in the body someplace, because that's what gets sick.
So, I love the physical exam, and I think it's a rich source of information, of connection. And of course, and I don't mean to go over, of course I listen to the patient. I think what's really important is to spend time, kind of slow, quiet time, especially that first few minutes.
You probably find that as an interviewer, right, there's a kind of connection that's established, and you kind of get a sense of who this person is, and in my case as a doc, you know, how much energy do they have? How sick are they?
Right. Is it being taught still, and then just not applied? Or are we losing that in medical school because it's being replaced by other things that feel more pressing?
You said it better than I could say it, that's it exactly. It's being completely replaced, and that's another one of my concerns. That's another thing that really, I mean, I've been completely tied up with this book, and explaining, you know, trying to show with my stories, not to say it, but to give examples of where just touching the patient, just examining the patient, there's the diagnosis. And it is being completely lost.
And sometimes the solution might be interesting, you tell a story in your book, and I am going to forget where you were when this occurred, but there's a man who comes in. He has a nosebleed, it will not stop, the doctor is basically, you know, trying to stop the blood, patient's kind of freaking out, and he stands there and he thinks, for like a minute. Which must seem like a terribly long time, when blood is pouring out of your nose, and then he comes up with this really innovative solution.
So, the ability for a physician to, I mean, you can't go look up in the literature, anything. He had to think it through, what was he, tell us what he was thinking, and the value just of taking that 60 seconds or so to use everything that he had learned and apply it to the situation in front of him.
Yeah, that's beautiful, I love that you picked that out. It's one of my ... Well, I mean, it's hard to come up with favorites, but it's definitely a moment for me, 'cause I was a young medical student then, and I hadn't seen very much. And I was scared of blood, too, and everybody was kind of scared of blood. And this, was a little clinic in the middle of nowhere, so the hospital was a 30-minute ambulance drive away.
And this guy came in, he was a farm worker, and his nose wasn't just bleeding, it was gushing. It was what, I learned at that time, was called a posterior bleed. Where usually your nosebleeds are from the front of your nose, so when you press your nose, you can stop it. But sometimes a blood vessel breaks way in the back, and it's usually an artery, so it's pumping, it's blood gushing, and you can't stop it. It needs to be surgically stopped, usually, or with little plugs that are surgically put in the back to tamponade it.
So, it was really scary, because the ambulance wasn't going to be there for 30 minutes. And his blood pressure was sky high, and we were a little clinic, and we didn't have the medicines to bring -- we knew if we brought the blood pressure down and calmed the patient down, that that would be the best thing to do -- but we didn't have any fancy medications like that.
And as Dr. Howard, just we watched him, he started the IV, he called the ambulance himself. But then, he tried stopping the blood with his own fingers, but as I said, it was a posterior bleed. And then he was just sitting there, and just get quiet. And I think at that moment, he was reflecting, but not in a linear conscious way, he was more like thinking, whatever thinking really is. And it was something we don't do that much.
And he came up with this brilliant idea, because we did have one IV medication that would work right away, in the clinic, that was called Thorazine, which was a medicine for psychoses, for people that are schizophrenic, and acute psychoses, but has a side effect. And the side effect is, it not only calms the patient down, and sedates the patient, but it also lowers the blood pressure. It's a side effect of medicine.
And so he innovatively gave, had the nurse get him one, gave him this medicine in his IV. And within like a minute, the blood pressure came down, the patient calmed down, and after a few more minutes, the blood stopped gushing and was just sort of trickling, and then the ambulance arrived.
When I watched him do that, there was like many different parts of it, but the part you pick on is that quiet space, that he went into in the midst of chaos, in the midst of an emergency. Where he went to someplace in himself that was calm, quiet, thoughtful. And then came up with the answer that was so out of the box.
Right. I'm reading that story, and I ... Again, you're a powerful writer, and an amazing storyteller from a literary standpoint. But just the story that you are telling, it made me get surprisingly emotional. And I was trying to unpack why that was. Why am I getting teary-eyed because Dr. Howard had a minute to think? Or that he chose, that he solved that problem through kind of finding that quiet space.
And all I could come up with, and I'm curious what your thoughts, is that it's so unusual in this day and age, to see that sort of story play out, in my experience anyway. So there was almost a yearning for a medicine that moved in that way. Do you think, do you feel that, from readers, and from people that you talk to, that there's ... I'm sure you feel it from doctors, but do you hear it from patients, that there's a longing, to sort of reincorporate some of the slower medicine techniques back into how we deal with medicine today?
Well, that was beautiful, thank you, 'cause that's what I intended to create, because that's how I felt, myself. And even telling that story to you now, it moves me. Right? It's moving. And I think it's the ... It's the vocation that it, it's the profession it's the sort of really noble kind of non ... It's everything that we're not doing now, because it's not just ...
To answer you, yes. Doctors, and patients, and medical students, and nurses, but even administrators. I've gotten, God's Hotel, I've gotten thousands of emails from people, I've spoken hundreds and hundreds of times, all over the place, because in a way this is just an example of what we all need in our lives.
I mean, I can't speak to being on the radio, but you know, teachers, and almost any profession you come up with, there's a way in which it's been downgraded into providing some other kind of commodity. You know, I sometimes think we should call mothers childcare providers.
I mean, same idea, yeah. Or teachers are information providers. And firemen are, I don't know, fire prevention care providers. You know, this whole idea that we're just commodity providers. It's not the human experience. It's not satisfying, it's not beautiful, it's not loving, and it's not satisfying. And it's not efficient, thank god.
I mean, my whole argument would fall apart if in fact it's required, you know, tons of time and everything else, but it doesn't. I mean, the 50 second that Dr. Howard knew he could take, and did take, you know, I mean he might have prevented the guy dying, but more likely he prevented the guy from coding, and having to be resuscitated and in the ICU getting tons of blood, right, by his 50 seconds. And so it isn't just, it's actually more efficient.
Right. Saved a lot of money, probably, too.
Saved a lot of money.
Yes, right. Let's go back to some of your, let's go back to medieval times, and let's talk about some of the inspiration that you were able to find from a surprising source. Hildegard von Bingen, is that how you say that?
You said it just right, Hildegard von Bingen, but in English, we are saying Hildegard of Bingen, because Bingen was the town she was from. And her name was Hildegard, and she was a nun in the 12th century. So this was the century of Richard the Lionhearted, and Henry II, and Beckett, and Saint Bernard. So this was a really fascinating, rich, and interesting century.
So one of the reasons that Hildegard was so interesting is 'cause she knew all these people. And of course, because she was a woman. And so, when I discovered her, I had no idea that women had written books on medicine, which she did, or were medical practitioners, which she was. But she was also a nun, an abbess, a mystic, a musician, a theologian. She was amazing.
And the thing that was so fascinating is that, unlike so many other women, almost all of her work had survived. So it was one of the few cases where we could actually really, really get into an actual experience of what she did, and how she lived, and what she thought. And then it turned out she'd written this medical book. So it was pre-modern, it was way before we had any of the modern technologies, but also any of the ways of thinking that we have, about machines and factories, and industries.
So, she was the antidote to my, my own looking for what was missing in modern healthcare. Right, 'cause I had these really moving experiences, and I learned that medicine was a science, and a craft, and an art. But I felt like something was still missing. And so I started looking around in alternative medicines and homeopathy, and it just didn't ... Chinese medicine, Ayurvedic medicine, for what was missing.
And I really found them not useful, and then I discovered Hildegard's medical books, oh from almost a thousand years ago, and it was really different from the medicine I practiced, and yet it was clearly real medicine. You know, it wasn't eye of newt, toe of frog, that you'd expect, you know, waving holy water around. She was giving people medicine, she was taking their pulses, she was looking at them. She was doing a lot of the things that I learned to do, but she had a different take on it.
So, clearly, it took me years to figure it out. But eventually it hit me that her idea of the body was more, that it was more like a plant, than our idea of the body, which is like a machine. And you can say, "Well, what is the fundamental difference?" Well, the difference is that when you think about it, a machine can't fix itself, right?
A machine needs a doctor, that's a mechanic, to fix it. But the plant has, can heal itself, and does heal itself. And Hildegard had a word for that healing power that a plant has. She called it "viriditas," from the Latin viridis, that means green. So she thought of it as greening power, and her innovation in her time was to see that human beings had their own viriditas. And that the job of the doctor, in her mind, was to remove what's in the way of the patient's own viriditas to heal it, and to support that viriditas.
And that was very life-changing for me.
So, elaborate a little bit, Dr. Sweet, if you would on this notion of, give me a chronic condition, that you need to really remove what's in the way to provide that healing.
Well, in general. In general. I wouldn't pick a specific condition, but what I would do, what I did see, is people with chronic illnesses ... So, typically at Laguna Honda Hospital, this old-fashioned hospital, when I'd get a new patient, they were on average, on average, on between 15 and 26 medications. You talk about being in the way, right?
And most of those medications, they'd collected over the years, because they'd been sick for a long time. And nobody had ever had the time to, you know, examine them and go, "Gosh, they used to have high blood pressure, but they don't anymore." Or, "They have a diagnosis of diabetes, but I don't think they have diabetes."
Nobody had the time to kind of look at that and look into it in them, but I did. So I found that most patients only needed about four or five medications. So I'd gradually take them off the 10 or 12 or so that they didn't need, and two things, I realized.
First of all, it saved a ton of money. When I first started thinking of what I call the efficiency of inefficiency, that even though it looks inefficient for a doctor to spend time with a patient? If I can remove like 10 medications, that's hundreds of dollars a day, for a lot of medications, not to speak of all the side effects and adverse reactions. So, naturally, when the patients were off 10 medications they didn't need, they got a lot better. So that's the removing what's in the way, that's a lot of what's in the way, is medications people don't need, diagnoses they don't have.
A lot of their, you know, just in general, I think people ... I'm struck by how anxious people are. Everybody. It's like we've all, today, these last few years, it's this incredibly ... It's sad, really. And I was struck by this, I don't know how much time we have left, but I did ...
You know, I like to walk, long distances, in Europe particularly. I did the pilgrimage to Santiago de Compostela, and this year, I go with a certain friend of mine. We walked over, from Switzerland, we walked over the Alps into Italy. And I was so struck when we got into Italy, this one area that comes off of the Alps, is its own little area, where they don't speak Italian, they speak French.
And I was so struck by the quality of the people somehow walking through there. They seemed to not have what everybody else has these days, this crazy, I don't know what it is about them, but they just didn't have it. And that difference between ... There was this, I don't know, this slowness about them. They weren't slow, but I would call it slow as a style.
They had wonderful food, the kids were playing in the streets. We'd walk through these little villages, and several times, we'd, the marching band of the village would be parading around with their trumpets and their trombones, and their ... It was just a trip, it was a trip.
And I was just, it just got me about this tension, this craziness, this frantic-ness of people today. That's the other thing to be removed. 'Cause I think that's the source of a lot of illness and not-wellness.